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General NPI Number Information
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NPI Number | 1982656963
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Entity Type | Individual
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Provider Name | TERRENCE D WILKIN MD
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 611 E DOUGLAS RD STE 200
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City | MISHAWAKA
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State | IN
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Zip | 46545-1465
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Country | US
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Telephone | 574-272-5347
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Fax | 574-272-8617
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Provider Business Mailing Address
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Address Line | 121 S SAINT LOUIS BLVD
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City | SOUTH BEND
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State | IN
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Zip | 46617-2924
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Country | US
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Telephone | 574-233-3123
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Fax | 574-233-3125
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 01048976A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 01048976A
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License Number State | IN
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